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Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Tumours of the upper third can infiltrate the liver, while those of the lower third can infiltrate the duodenum and pancreas. Tumours also spread to the hilar, superior mesenteric and coeliac lymph nodes. The liver is the most common site of distant metastases, although lung and bone may also be involved.
The Stomach
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
Proximal gastric lesions require a more thoughtful approach. Lesions located in the proximal fundus or cardia will require resection of at least 3 cm of the distal esophagus, and at least 5 cm distal to the tumor on the gastric site. Frozen sections must be obtained from both lines of resection. The lesser and greater ometums are to be resected as well as the spleen. The left gastric is ligated at its origin and the celiac lymph nodes are dissected. Proximal radical gastrectomy and reconstruction by esophagogastrostomy is an acceptable approach, as the distal stomach wall can resist the possibility of local-regional recurrence (in the stomach bed) and potential obstruction. Others do advertise total radical gastrectomy with esophagojejunostomy because it is easier anastomosis than the esophagogastrostomy.
SBA Answers and Explanations
Published in Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury, SBAs for the MRCS Part A, 2018
Vivian A. Elwell, Jonathan M. Fishman, Rajat Chowdhury
Colonic lymphatic drainage terminally reaches superior and inferior mesenteric lymph nodes, which belong to the pre-aortic lymph nodes. Lymph from colon passes through four sets of lymph nodes: Epicolic (lie on the serosal wall of gut) → Paracolic (on medial side of ascending/descending colon and mesenteric border of transverse/sigmoid colon) → Intermediate (on named branches of colonic vessels) → Pre-terminal/pre-aortic (on inferior/superior mesenteric vessels). The efferents from the pre-aortic lymph nodes drain into the coeliac lymph nodes (terminal), which also belong to the pre-aortic category. Coeliac lymph nodes then drain into the intestinal trunks, which ultimately join the cisterna chyli.
Clinical practice and outcome of radiotherapy for advanced esophageal squamous cell carcinoma between 2002 and 2018 in China: the multi-center 3JECROG Survey
Published in Acta Oncologica, 2021
Chen Li, Xin Wang, Lan Wang, Junqiang Chen, Wencheng Zhang, Qingsong Pang, Yidian Zhao, Xinchen Sun, Kaixian Zhang, Gaofeng Li, Ling Li, Xueying Qiao, Miaoling Liu, Yadi Wang, Lei Deng, Wenqing Wang, Nan Bi, Tao Zhang, Wei Deng, Wenjie Ni, Xiao Chang, Weiming Han, Zongmei Zhou, Jun Liang, Qinfu Feng, Lvhua Wang, Dongfu Chen, Jima Lv, Shuchai Zhu, Chun Han, Zefen Xiao
This study adopted the 6th edition of UICC/AJCC staging manual, which is the most commonly used staging system in mainland China for non-surgical patients. Results showed that this version of staging manual had a relatively satisfactory predictive value for non-surgical ESCC patients. In the whole group, with the increase of the clinical stage, the 5-year OS rates decreased from 61.0% to 22.8%, and the difference between the groups was statistically significant (p < 0.001). However, when pairwise comparisons were performed for each stage, no differences were found between the OS of stage III patients and stage IVA patients (p = 0.21), or between stage IVA patients and stage IVB patients (p = 0.12). This result suggests the modification of supraclavicular/celiac lymph nodes from non-regional to regional may allow for better stratification of overall survival for ESCC patients, which correlates to the findings from several previous studies [19,20].
Optic Nerve Infiltration in Systemic Metastatic Retinal Lymphoma (SMRL): Multimodal Imaging and Challenges in Diagnosis
Published in Ocular Immunology and Inflammation, 2021
Mohd Feendi Bin Mohd Fauzi Yap, Ayesha Mohd Zain, Nor Rafeah Tumian, Sivakumar Palaniappan, Rona Asnida Nasaruddin, Norshamsiah Md Din
A 45-year-old man was diagnosed with diffuse large B-cell lymphoma (DLBCL) Stage IV when he presented with epigastric pain and pancytopenia. Bone marrow aspirate showed hemophagocytic activity and CT scan showed para-aortic mass. Celiac lymph node biopsy confirmed the diagnosis of DLBCL. He was treated with six cycles of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone (R-CHOP) and attained complete remission. Six months later, he complained of painless blurring of vision OD for 2 weeks associated with floaters. Visual acuity (VA) was perception of light (PL) OD, and 6/9 OS with positive relative afferent pupillary defect (RAPD) OD. Ocular examination OU showed fine keratic precipitates, anterior chamber cells of 1+, and localized vitritis which was denser OD > OS. A dilated fundus examination showed no disc edema, retinitis, choroiditis, or vasculitis.
Hepatocellular Carcinoma in a β-Thalassemia Intermedia Patient: Yet Another Case in the Expanding Epidemic
Published in Hemoglobin, 2018
Hassan M. Moukhadder, Joseph E. Roumi, Rayan Bou-Fakhredin, Ali T. Taher
He was hospitalized in 2014 for work-up of persistent epigastric pain associated with signs of liver disease. Abdominal ultrasound was uneventful, but upper gastrointestinal endoscopy revealed esophageal and gastric varices, for which propranolol therapy was started. In September 2016, the patient presented to our attention with gnawing epigastric pain, unintentional weight loss and worsening jaundice. Magnetic resonance imaging (MRI) of the abdomen showed evidence of chronic liver disease, a 20 × 17 mm solid mass in segment IV and a 30 × 25 mm solid mass in segment VI, and a few enlarged retroperitoneal and celiac lymph nodes (Figure 1). The patient was diagnosed with Child-Pugh class B liver cirrhosis. His serum α-fetoprotein (AFP) level was 1616.82 ng/mL at the time of diagnosis (normal < 13.0 ng/mL). Although his serum ferritin level 1 month earlier was 832.0 ng/mL and his liver iron concentration (LIC) was 1.19 mg Fe/g dry weight (dw), serum ferritin concentration was 3860.0 ng/mL and LIC peaked at 7.3 mg Fe/g dw in January 2013.